改良侧脑室外引流术治疗儿童结核性脑膜炎伴脑积水的初步探讨

目的 探讨改良侧脑室外引流治疗儿童结核性脑膜炎伴梗阻性脑积水的可行性。方法 回顾性分析西安交通大学医学院第一附属医院和温州医学院第二附属医院2007至2010年间30例结核性脑膜炎伴脑积水患儿,采用改良侧脑室外引流术6例,其中Ⅲ级5例,Ⅳ级1例;Ommaya储液囊外引流术9例,Ⅱ级6例,Ⅲ级3例;脑室腹腔分流术15例,Ⅱ级1例,Ⅲ级12例,Ⅳ级2例。比较术后脑脊液变化、并发症及预后。结果 改良侧脑室外引流术组6例经治疗后4例4～6个月内拔除外引流管,外引流管最长留置时间6个月,未发生颅内感染及与外引流管相关的严重并发症;2例改行脑室腹腔分流术。脑脊液细胞数、蛋白含量恢复正常时问、预后等方面与脑室腹腔分流组无显著性差异。结论 改良侧脑室外引流术治疗儿童结核性脑膜炎伴重度梗阻性脑积水有效且较为安全,部分患儿经治疗脑积水缓解,避免了分流装置长期留置带来的一系列并发症,是一种值得临床进一步探讨应用的方法 。

Role of modified external ventricular drainage in the management of children with tuberculous meningitis hydrocephalus

Objective To explore the role of modified external ventricular drainage (mEVD) in the treatment of tuberculous meningitis obstructive hydrocephalus in children. Methods The records were retrospectively reviewed for 30 pediatric patients of tuberculous meningitis with hydrocephalus (TBMH)undergoing surgery between January 2007 and December 2010. The procedures included ventricular abdomen subcutaneous drainage (mEVD) (n =6), Ommaya reservoir ( n =9) and ventriculoperitoneal shunt (VPS)(n =15). White cell count and protein content of cerebrospinal fluid were measured repeatedly. And their clinical outcomes were assessed at 6 months post-operation. Results External drainage was extracted for 4 of 6 TBMH patients after 4 - 6 months of mEVD. Neither intracranial infections nor serious postoperative complications occurred. Two of 6 TBMH received VPS substituting for mEVD. No statistically significant difference in white cell count, protein content of cerebrospinal fluid and outcome was found between the mEVD and VPS groups. Conclusion Ventricular abdomen subcutaneous drainage is both safe and efficacious in the management of children with tuberculous meningitis hydrocephalus. This approach may avoid possible complications and long-term indwelling shunt so that it is worthy of further clinical application.